Provider Demographics
NPI:1124728068
Name:LINDQUIST, TIFFANY ANN (LAC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:LINDQUIST
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 7TH AVE W
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5685
Mailing Address - Country:US
Mailing Address - Phone:406-491-5830
Mailing Address - Fax:
Practice Address - Street 1:1645 US HIGHWAY 93 S STE D
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5776
Practice Address - Country:US
Practice Address - Phone:406-314-6565
Practice Address - Fax:406-314-6565
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-62550101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)